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Chen P, Xin X, Xiao S, Liu H, Liu X, He N, Ding Y. Cognitive impairment and neurocognitive profiles among people living with HIV and HIV-negative individuals older over 50 years: a comparison of IHDS, MMSE and MoCA. J Neurovirol 2024:10.1007/s13365-024-01205-y. [PMID: 38709469 DOI: 10.1007/s13365-024-01205-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024]
Abstract
We aimed to examine the l differences in the assessment of neurocognitive impairment (NCI) using cognitive screening tools between PLWH and HIV-negative individuals and further compare the neurocognitive profiles between the two groups. This was baseline evaluation of Pudong HIV Aging Cohort, including 465 people living with HIV (PLWH) and 465 HIV-negative individuals aged over 50 years matched by age (± 3 years), sex and education. NCI was assessed using the Chinese version of Mini-mental State Examination (MMSE), the International HIV Dementia Scale (IHDS) and Beijing version of Montreal Cognitive Assessment (MoCA). In total, 258 (55.5%), 91 (19.6%), 273 (58.7%) of PLWH were classified as having NCI by the IHDS, MMSE and MoCA, compared to 90 (19.4%), 25 (5.4%), 135 (29.0%) of HIV-negative individuals, respectively (p < 0.05); such associations remained significant in multivariable analysis. PLWH showed a larger overlap of NCI detected by IHDS, MMSE, and MoCA. IHDS and MoCA detected almost all of the NCI detected by MMSE. IHDS-motor and psychomotor speeds and MoCA-executive function showed the greatest disparities between two groups. In multivariable analysis, older age and more depressive symptoms were positively associated with NCI regardless of the screening tools or HIV serostatus. PLWH over 50 years old display a higher prevalence of NCI and distinct neurocognitive profiles compared to HIV-negative individuals, despite viral suppression. Given the more considerable overlap in NCI classification in PLWH, it is advisable to choose one screening tool such as IHDS or MoCA to identify those potentially having NCI and then refer to more comprehensive neuropsychological assessment.
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Affiliation(s)
- Panpan Chen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 2000323, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200136, China
| | - Xin Xin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 2000323, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200136, China
| | - Shaotan Xiao
- Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200136, China
| | - Hantao Liu
- Pudong New Area Beicai Community Health Service Center, Shanghai, 200111, China
| | - Xin Liu
- Pudong New Area Puxing Community Health Service Center, Shanghai, 200190, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 2000323, China.
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 2000323, China.
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Makinson A, Allavena C, Abulizi X, Slama L, Cases A, Trouillet MB, Martin-Blondel G, Geny C, Leclercq P, Cazanave C, Bonnet F, Naqvi A, David-Chevallier P, Arvieux C, Katlama C, Cabie A, Andriantsoanirina V, Blain H, Meyer L. Frailty and prefrailty phenotypes increase the odds of abnormal cognitive impairment screens in people with HIV. AIDS 2023; 37:2161-2168. [PMID: 37534690 DOI: 10.1097/qad.0000000000003681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Evaluate whether prefrail and frail people with HIV (PWH) have a higher risk of cognitive impairment on screens. METHODS Analysis of PWH aged 70 or older included in the ANRS EP66 SEPTAVIH cohort, on antiretroviral therapy for at least 12 months and with a MoCA test at enrolment. Adjusted risk of a Montreal Cognitive Assessment (MoCA) less than 26 was compared in frail/prefrail versus robust PWH. RESULTS A total of 503 PWH were enrolled with a median age of 73 years, IQR [71-77], 81.5% were male, 73.8% were French natives, 32.9% had low socio-economic status (EPICES score >30.2), and 41.3% were college graduates; 27.3% had a history of clinical AIDS. A total of 294 (58.5%) PWH had a MoCA score less than 26; 182 (36%) a MoCA score 23 or less. Frailty, prefrailty and robustness were found in 13.1, 63.6 and 23.3% participants, respectively. PWH with a MoCA less than 26 had a significantly higher risk of being frail/prefrail, this before [odds ratio (OR) = 2.31; 95% confidence interval (CI) 1.50-3.57], and after adjustment for confounders (OR = 1.80; 95% CI 1.07-3.01). The risk of being frail/prefrail in patients with a MoCA 23 or less was higher (adjusted OR = 2.75; 95% CI 1.46-5.16). Other factors independently associated with a MoCA less than 26 were older age, birth outside of France and a lower education level and being diabetic. CONCLUSION Abnormal MoCA screens were frequent in our cohort of PWH aged 70 or older with controlled HIV disease. Cognitive impairment should be systematically screened in frail/prefrail PWH. Frailty/prefrailty, diabetes and social factors, but not HIV-related factors, are important determinants of cognitive function in PWH with controlled disease.
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Affiliation(s)
- Alain Makinson
- Infectious Disease Department & INSERM U175- CHU La Colombière, University of Montpellier, Montpellier
| | - Clotilde Allavena
- Service de Maladies Infectieuses, UE 1413, CHU de Nantes, Université Nantes, Nantes
| | - Xian Abulizi
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
| | - Laurence Slama
- Infectious Diseases Hôtel Dieu Hospital, APHP, Paris, France & Centre de Recherche épidémiologie et StatistiqueS Université de Paris Cité (CRESS-UMR1153), France
| | - Antoine Cases
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
| | | | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse& Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III
| | - Christian Geny
- Department of Geriatrics, MUSE Montpellier University, Montpellier
| | - Pascale Leclercq
- Infectious Diseases Department, CHU de Grenoble Alpes, La Tronche
| | - Charles Cazanave
- Infectious Disease Department & UMR 5234 CNRS, Microbiologie Fondamentale et Pathogénicité, Antimicrobial Resistance in Mycoplasmas and Gram-Negative Bacteria, Bordeaux University Hospital
| | - Fabrice Bonnet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre & CHU de Bordeaux, Saint-André Hospital, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, Cedex
| | - Alissa Naqvi
- CHU de Nice Archet 1 Service de Maladies Infectieuses et Tropicales, Nice
| | - Perla David-Chevallier
- Service de médecine interne et d'immunologie clinique- AP-HP. Université Paris Saclay - Hôpital Béclère-Le Kremlin Bicêtre, FR
| | - Cédric Arvieux
- Département des Maladies Infectieuses, Centre Hospitalier et Universitaire de Rennes, Rennes
| | - Christine Katlama
- Sorbonne University Infectious Diseases Department APHP, Hôpital Pitié Salpêtrière, Paris
| | - André Cabie
- PCCEI, Univ Montpellier, INSERM, EFS, Univ Antilles, Montpellier, France, CIC Antilles Guyane, INSERM CIC1424, Fort-de-France, France
| | - Valérie Andriantsoanirina
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
| | - Hubert Blain
- Department of Geriatrics, MUSE Montpellier University, Montpellier
| | - Laurence Meyer
- Department of Public Health and Epidemiology, AP-HP, Bicêtre Hospital, Paris-Saclay University, & INSERM CESP U1018, Le Kremlin Bicêtre
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Kundura L, Cezar R, Pastore M, Reynes C, Deverdun J, Le Bars E, Sotto A, Reynes J, Makinson A, Corbeau P. Low levels of peripheral blood activated and senescent T cells characterize people with HIV-1-associated neurocognitive disorders. Front Immunol 2023; 14:1267564. [PMID: 37954593 PMCID: PMC10634248 DOI: 10.3389/fimmu.2023.1267564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background HIV infection induces a 75% increase in the risk of developing neurocognitive impairment (NCI), which has been linked to immune activation. We therefore looked for immune activation markers correlating with NCI. Method Sixty-five people aged 55-70 years living with controlled HIV-1 infection were enrolled in the study and their neurocognitive ability was assessed according to the Frascati criteria. Fifty-nine markers of T4 cell, T8 cell, NK cell, and monocyte activation, inflammation and endothelial activation were measured in their peripheral blood. White matter hyperintensities (WMH) were identified by magnetic resonance imaging. Double hierarchical clustering was performed for the activation markers and 240 patients including the 65 whose neurocognitive performance had been evaluated. Results Thirty-eight percent of volunteers presented NCI. Twenty-four percent of them were asymptomatic and fourteen percent had a mild disorder. Strikingly, activated (HLA-DR+) as well as senescent (CD57+CD28-CD27±) T4 cells and T8 cells were less prevalent in the peripheral blood of participants with NCI than in participants without the disorder. Accordingly, the percentage of HLA-DR+ T4 cells was lower in volunteers with periventricular and deep WMH. The double hierarchical clustering unveiled six different immune activation profiles. The neurocognitive performances of participants with two of these six profiles were poor. Here again, these two profiles were characterized by a low level of T4 and T8 cell activation and senescence. Conclusion Our observation of low circulating levels of activated and senescent T cells in HIV-1 patients with NCI raises the interesting hypothesis that these lymphocytes may be recruited into the central nervous system.
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Affiliation(s)
- Lucy Kundura
- Institute of Human Genetics, Centre National de la Recherche Scientifique-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, France
| | - Renaud Cezar
- Immunology Department, Nîmes University Hospital, Place du Pr Debré, Nîmes, France
| | - Manuela Pastore
- Institute of Functional Genomics UMR5203 and BCM, CNRS-INSERM-Montpellier University, 141 rue de la Cardonille, Montpellier, France
| | - Christelle Reynes
- Institute of Functional Genomics UMR5203 and BCM, CNRS-INSERM-Montpellier University, 141 rue de la Cardonille, Montpellier, France
| | - Jérémy Deverdun
- Institute of Human Functional Imaging, Montpellier University Hospital, Montpellier, France
| | - Emmanuelle Le Bars
- Institute of Human Functional Imaging, Montpellier University Hospital, Montpellier, France
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nîmes University Hospital, Nîmes, France
- Faculty of Medicine, Montpellier University, Montpellier, France
| | - Jacques Reynes
- Faculty of Medicine, Montpellier University, Montpellier, France
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Alain Makinson
- Faculty of Medicine, Montpellier University, Montpellier, France
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Pierre Corbeau
- Institute of Human Genetics, Centre National de la Recherche Scientifique-Montpellier University UMR9002, 141 rue de la Cardonille, Montpellier, France
- Immunology Department, Nîmes University Hospital, Place du Pr Debré, Nîmes, France
- Faculty of Medicine, Montpellier University, Montpellier, France
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Lam JO, Hou CE, Gilsanz P, Lee C, Lea AN, Satre DD, Silverberg MJ. Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care. Open Forum Infect Dis 2023; 10:ofad284. [PMID: 37342311 PMCID: PMC10279416 DOI: 10.1093/ofid/ofad284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
Background Little is known about the prevalence of undiagnosed cognitive impairment and its impact on instrumental activities of daily living (IADL) among people with HIV (PWH) in primary care. Methods PWH were recruited from an integrated health care setting in the United States. PWH were eligible for recruitment if they were ≥50 years old, taking antiretroviral therapy (ie, ≥1 antiretroviral therapy [ART] prescription fill in the past year), and had no clinical diagnosis of dementia. Participants completed a cognitive screen (St. Louis University Mental Status exam) and a questionnaire on IADL (modified Lawton-Brody). Results Study participants (n = 47) were mostly male (85.1%), 51.1% White, 25.5% Black, 17.0% Hispanic, and the average age (SD) was 59.7 (7.0) years. Overall, 27 (57.5%) participants were categorized as cognitively normal, 17 (36.2%) as having mild cognitive impairment, and 3 (6.4%) as having possible dementia. Of the 20 participants with mild cognitive impairment or possible dementia, 85.0% were men, the average age (SD) was 60.4 (7.1) years; 45.0% were White, 40.0% were Black, 10.0% were Hispanic, and 30.0% reported difficulty with at least 1 IADL. Most (66.7%) attributed difficulty with IADL primarily (33.3%) or in part (33.3%) to cognitive problems. Conclusions Undiagnosed cognitive impairment is frequent among ART-treated PWH, with possible elevated risk among Black PWH, and may be accompanied by difficulty with IADL. Efforts are needed to optimize identification of factors contributing to cognitive and IADL difficulties among ART-treated PWH in primary care.
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Affiliation(s)
- Jennifer O Lam
- Correspondence: Jennifer Lam, PhD, MPH, Division of Research, Kaiser Permanente Northern California; 2000 Broadway, Oakland, CA 94612 (); or Michael Silverberg, PhD, MPH, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ()
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California, USA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Michael J Silverberg
- Correspondence: Jennifer Lam, PhD, MPH, Division of Research, Kaiser Permanente Northern California; 2000 Broadway, Oakland, CA 94612 (); or Michael Silverberg, PhD, MPH, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 ()
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Boonyagars L, Kiatsoongsong N, Winitprichagul S. HIV-Associated Dementia: Associated Factors and Characteristics of Cognitive Domain Abnormalities in Elderly People Living with HIV Treated with Highly Active Antiretroviral Therapy. Am J Trop Med Hyg 2022; 107:1250-1257. [PMID: 36315995 PMCID: PMC9768268 DOI: 10.4269/ajtmh.22-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/05/2022] [Indexed: 12/30/2022] Open
Abstract
This study aimed to evaluate the prevalence and associated factors of HIV-associated dementia (HAD) in people living with HIV (PLWH) aged ≥ 60 years who are currently treated with highly active antiretroviral therapy. A cross-sectional study was conducted on adult (age ≥ 60 years) PLWH at the infectious clinic, Vajira Hospital, Navamindradhiraj University, Thailand, between August 2019 and March 2021. We collected the patients' characteristics and performed Montreal Cognitive Assessment and Instrumental Activities of Daily Living test to determine whether they have HIV-associated neurocognitive disorders (HAND), which we further classified into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HAD. Finally, we evaluated the prevalence, associated factors, and characteristics of cognitive domain abnormalities in these patients. We enrolled 84 elderly PLWH patients consisting of 43 (51.2%) males. The mean patient age was 63 years (SD ± 3.9), and the median duration of HIV infection was 13 (SD ± 5.7) years. All the patients had undetectable HIV viral load. Among them, seven (8.3%) had no neurocognitive impairment, 61 (72.6%) had ANI, three (3.6%) had MND, and 13 (15.5%) had HAD. After confounder adjustment, the patient age of ≥ 65 years was found to be significantly associated with dementia (odds ratio = 5.97, 95% CI: 1.51-23.57). Significant difference in the mean score of all cognitive domains was observed between the patients with HAD and those with normal cognitive status. HAND is common in PLWH. Age older than ≥ 65 years is a risk factor of HAD.
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Affiliation(s)
- Lakkana Boonyagars
- Division of Infectious Diseases, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand
| | - Nucharee Kiatsoongsong
- Department of Internal Medicine, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand
| | - Supharat Winitprichagul
- Division of Neurology, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand,Address correspondence to Supharat Winitprichagul, Division of Neurology, Faculty of Medicine, Navamindradhiraj University, Bangkok 10300, Thailand. E-mail:
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Li R, Gao Y, Wang W, Jiao Z, Rao B, Liu G, Li H. Altered gray matter structural covariance networks in drug-naïve and treated early HIV-infected individuals. Front Neurol 2022; 13:869871. [PMID: 36203980 PMCID: PMC9530039 DOI: 10.3389/fneur.2022.869871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWhile regional brain structure and function alterations in HIV-infected individuals have been reported, knowledge about the topological organization in gray matter networks is limited. This research aims to investigate the effects of early HIV infection and combination antiretroviral therapy (cART) on gray matter structural covariance networks (SCNs) by employing graph theoretical analysis.MethodsSixty-five adult HIV+ individuals (25–50 years old), including 34 with cART (HIV+/cART+) and 31 medication-naïve (HIV+/cART–), and 35 demographically matched healthy controls (HCs) underwent high-resolution T1-weighted images. A sliding-window method was employed to create “age bins,” and SCNs (based on cortical thickness) were constructed for each bin by calculating Pearson's correlation coefficients. The group differences of network indices, including the mean nodal path length (Nlp), betweenness centrality (Bc), number of modules, modularity, global efficiency, local efficiency, and small-worldness, were evaluated by ANOVA and post-hoc tests employing the network-based statistics method.ResultsRelative to HCs, less efficiency in terms of information transfer in the parietal and occipital lobe (decreased Bc) and a compensated increase in the frontal lobe (decreased Nlp) were exhibited in both HIV+/cART+ and HIV+/cART– individuals (P < 0.05, FDR-corrected). Compared with HIV+/cART– and HCs, less specialized function segregation (decreased modularity and small-worldness property) and stronger integration in the network (increased Eglob and little changed path length) were found in HIV+/cART+ group (P < 0.05, FDR-corrected).ConclusionEarly HIV+ individuals exhibited a decrease in the efficiency of information transmission in sensory regions and a compensatory increase in the frontal lobe. HIV+/cART+ showed a less specialized regional segregation function, but a stronger global integration function in the network.
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Affiliation(s)
- Ruili Li
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yuxun Gao
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zengxin Jiao
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Bo Rao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- *Correspondence: Bo Rao
| | - Guangxue Liu
- Department of Natural Medicines, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Guangxue Liu
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Hongjun Li
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Mastrorosa I, Pinnetti C, Brita AC, Mondi A, Lorenzini P, Del Duca G, Vergori A, Mazzotta V, Gagliardini R, Camici M, De Zottis F, Fusto M, Plazzi MM, Grilli E, Bellagamba R, Cicalini S, Antinori A. Declining Prevalence of Human Immunodeficiency Virus (HIV)-Associated Neurocognitive Disorders in Recent Years and Associated Factors in a Large Cohort of Antiretroviral Therapy-Treated Individuals With HIV. Clin Infect Dis 2022; 76:e629-e637. [PMID: 35982541 PMCID: PMC9907497 DOI: 10.1093/cid/ciac658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorders (HAND) have been suggested as persistent even with effective antiretroviral therapy (ART). Aims were to evaluate HAND prevalence and associated factors, in a large cohort of people-with-HIV (PWH). METHODS ART-treated PWH, underwent a neuropsychological examination through a battery of 12 tests exploring 5 different domains, between 2009 and 2020, were included in this cross-sectional analysis. HAND were classified according to Frascati's criteria. Participants were defined as complaining or not-complaining if a cognitive complaint was reported or not. Chi-square for trend and multivariable logistic regression were fitted. RESULTS Overall, 1424 PWH were enrolled during four three-years periods. HAND prevalence was 24%; among complainers (572/1424), it was 38%, higher than among not-complainers (15%). Over the study period, a decreasing HAND prevalence was found in the entire population (P < 0.001) and in complaining (P < 0.001); in not-complaining it remained stable (P = 0.182). Factors associated with HAND were older age, lower educational level, lower current CD4+ T-cell count and HCV co-infection. Compared to nonnucleoside reverse transcriptase inhibitors, receiving dual and integrase strand transfer inhibitor (INSTI)-based therapies was associated with a decreased risk of HAND, as well as being tested in more recent years. CONCLUSIONS In this large cohort of ART-treated PWH, mostly virologically suppressed, a remarkable decreasing HAND prevalence was observed. Besides HIV- and patient-related factors, the reduced risk of HAND found with dual and INSTI-based regimens along with a more recent ART initiation, could suggest a potential role of new treatment strategies in this decline, due to their greater virologic efficacy and better tolerability.
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Affiliation(s)
- Ilaria Mastrorosa
- Correspondence: Ilaria Mastrorosa, Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Via Portuense 292, 00149 Roma, Italy ()
| | - Carmela Pinnetti
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Anna Clelia Brita
- Clinical Department of Infectious Diseases and Research, Psychology Service, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Annalisa Mondi
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Patrizia Lorenzini
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Giulia Del Duca
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Alessandra Vergori
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Valentina Mazzotta
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Roberta Gagliardini
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Marta Camici
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Federico De Zottis
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Marisa Fusto
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Maria Maddalena Plazzi
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Elisabetta Grilli
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Rita Bellagamba
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Stefania Cicalini
- Clinical Department of Infectious Diseases and Research, HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Lam JO, Lee C, Gilsanz P, Hou CE, Leyden WA, Satre DD, Flamm JA, Towner WJ, Horberg MA, Silverberg MJ. Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016. AIDS 2022; 36:437-445. [PMID: 34816805 PMCID: PMC8892590 DOI: 10.1097/qad.0000000000003134] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare dementia incidence and prevalence after age 50 years by HIV status. DESIGN Observational cohort, 2000-2016. METHODS People with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington DC). Dementia diagnoses were obtained from electronic health records. Incidence and prevalence of dementia, overall and by time period (i.e. 2000-2002, 2003-2004, …, 2015-2016), were calculated using Poisson regression. Trends were examined using Joinpoint regression. Rate ratios were used to compare dementia by HIV status with adjustment for sociodemographics, substance use, and clinical factors. RESULTS The study included 13 296 PWH and 155 354 PWoH (at baseline: for both, mean age = 54 years, 89% men; for PWH, 80% with HIV RNA <200 copies/ml). From 2000 to 2016, overall incidence of dementia was higher among PWH [adjusted incidence rate ratio (aIRR) = 1.80, 95% confidence interval (CI) = 1.60-2.04]. Dementia incidence decreased among both PWH and PWoH (-8.0 and -3.1% per period, respectively) but remained higher among PWH in the most recent time period, 2015-2016 (aIRR = 1.58, 95% CI = 1.18-2.12). The overall prevalence of dementia from 2000 to 2016 was higher among PWH [adjusted prevalence ratio (aPR) = 1.86, 95% CI = 1.70-2.04] and was also higher among PWH in 2015-2016 (aPR = 1.75, 95% CI = 1.56-1.97). CONCLUSION Reductions in dementia incidence are encouraging and may reflect ART improvement, but PWH are still more likely to have dementia than PWoH. Monitoring the burden of dementia among PWH is important as this population ages.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
| | - Jason A Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
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9
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Frailty in Aging People Living With HIV: a matched controlled Study. J Acquir Immune Defic Syndr 2021; 88:305-309. [PMID: 34238822 DOI: 10.1097/qai.0000000000002759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We compared the prevalence of frailty among aging People Living with HIV (PLHIV) with people without HIV from the ANS EP58 HAND 55-70 Study. METHODS Cross-sectional multicentric study which consecutively included 200 PLHIV and 1000 people without HIV from the French national CONSTANCES cohort, matched on age, sex and education level. PLHIV were aged 55-70 years, with a HIV viral load < 50 copies/mL and a lymphocyte T-CD4 level > 200 cells/µl for the last 24 and 12 months respectively. We measured frailty (>2 items) and pre-frailty (one or two items) using a proxy of the 5-item Fried score. Multivariate logistic regression was performed to assess the association between HIV and frailty/pre-frailty, adjusting for demographic, social, behavioural and comorbidity confounders. RESULTS Outcome measures were available for 192 PLHIV and 822 people without HIV. Median age was 62 years, and 84.9% were male. Among PLHIV, the median CD4 cell count was 645.5 cells/µl. Prevalence of frailty/pre-frailty was 5.73%/57.3% in PLHIV vs. 1.73%/52.2% in people without HIV, respectively. HIV was associated with pre-frailty/frailty (OR = 1.89 ; CI95% = 1.37 - 2.61), but after adjusting for social and behavioural factors and comorbidities, HIV was not significantly associated with pre-frailty/frailty (OR = 1.24; 95% CI = 0.84 - 1.81). In PLHIV only, frailty/prefrailty was associated with depressive symptomatology, kidney disease and time since HIV-infection. CONCLUSIONS Prevalence of frailty is increased in aging PLHIV with well controlled HIV-disease, but other factors than HIV are predominant, particularly depression and comorbidities.
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10
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Siegler EL, Moxley JH, Glesby MJ. Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation. HIV AIDS (Auckl) 2021; 13:467-474. [PMID: 33958897 PMCID: PMC8096415 DOI: 10.2147/hiv.s306532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient's needs. PATIENTS AND METHODS We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score. RESULTS A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen. CONCLUSION Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.
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Affiliation(s)
- Eugenia L Siegler
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Jerad H Moxley
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, 10065, USA
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11
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Lam JO, Hou CE, Hojilla JC, Anderson AN, Gilsanz P, Alexeeff SE, Levine-Hall T, Hood N, Lee C, Satre DD, Silverberg MJ. Comparison of dementia risk after age 50 between individuals with and without HIV infection. AIDS 2021; 35:821-828. [PMID: 33394681 PMCID: PMC7969394 DOI: 10.1097/qad.0000000000002806] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare risk of dementia after age 50 by HIV status among individuals in a primary care setting. DESIGN Observational cohort study; participants were identified from 2013 to 2017 and followed through 2019. METHODS Participants were people with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWOH), all at least 50 years old and with no prior diagnosis of dementia. The study setting was Kaiser Permanente Northern California, an integrated healthcare delivery system in the United States. Incident dementia diagnoses and baseline data on sociodemographics, smoking, alcohol use, other substance use, and clinical factors were gathered from the electronic health record. Cumulative proportion of incident dementia by HIV status was assessed using Kaplan--Meier curves. Unadjusted and adjusted hazard ratios for incident dementia by HIV status were generated using Cox proportional hazards models with age as the time scale. RESULTS The study included 5381 PWH and 119 022 PWOH (average age at baseline: 57 and 58 years, respectively). Incident dementia was diagnosed in 117 PWH and 2427 PWOH. By age 80, 25.8% of PWH and 13.8% of PWOH had been diagnosed with dementia, corresponding with an unadjusted hazard ratio of 1.98 (95% CI 1.64-2.39). After adjustment for sociodemographic, substance use, and clinical factors, including frequency of outpatient visits, the risk of dementia among PWH remained elevated (vs. PWOH, adjusted hazard ratio = 1.58, 95% CI 1.31-1.92). CONCLUSION Compared with PWOH, PWH were at 58% higher risk for dementia despite HIV treatment with ART. Research is needed to investigate the potential benefits of targeted risk factor management or earlier cognitive screening in this population.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco
| | - J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Nicole Hood
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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12
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Liu D, Zhao C, Wang W, Wang Y, Li R, Sun J, Liu J, Liu M, Zhang X, Liang Y, Li H. Altered Gray Matter Volume and Functional Connectivity in Human Immunodeficiency Virus-Infected Adults. Front Neurosci 2020; 14:601063. [PMID: 33343289 PMCID: PMC7744568 DOI: 10.3389/fnins.2020.601063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023] Open
Abstract
People living with human immunodeficiency virus (HIV) (PLWH) are at high risk of neurocognitive impairment. The pathogenesis of neurocognitive impairment remains unclear, and there is still no diagnostic biomarker. By coupling three-dimensional T1-weighted imaging and resting-state functional imaging, we explored structural and functional alterations in PLWH and examined whether such imaging alterations had the potential to denote neurocognitive function. A total of 98 PLWH and 47 seronegative controls aged 20–53 years were recruited. Structural alterations were first explored between HIV-negative controls and PLWH. Subsequently, brain regions showing gray matter alterations were used as seeds for separate whole-brain functional connectivity (FC) analysis. Finally, the relationships between imaging alterations and cognitive function were explored. PLWH suffered from thalamus, occipital lobe, and hippocampus/parahippocampus atrophy. Visual cortices in PLWH showed decreased anticorrelation with the posterior cingulate cortex and left angular gyrus of the default mode network. FC within the visual cortices (between the left calcarine and right calcarine) and in the thalamic prefrontal circuit and between the thalamus and somatosensory association cortex were also altered. In addition, FC between the left thalamus and right dorsolateral prefrontal cortex in the cognitively impaired group was significantly different from that in the cognitively normal group in PLWH. Partial correlation analysis uncorrected for multiple comparisons suggested that some imaging alterations can be associated with neurocognition. Our study supports the presence of brain atrophy and functional reconfiguration in PLWH. Imaging alterations can be associated with neurocognitive function. We hold that neuroimaging is a promising approach in evaluating PLWH and might have the potential to clarify the pathogenesis of HIV-associated neurocognitive disorder.
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Affiliation(s)
- Dan Liu
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Cui Zhao
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Wang
- Department of Radiology, Beijing Second Hospital, Beijing, China
| | - Ruili Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jun Sun
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiaojiao Liu
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Mingming Liu
- Physical Examination Center, Cangzhou Central Hospital, Hebei, China
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Ying Liang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing University of Aeronautics and Astronautics, Beijing, China
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13
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Saag MS, Gandhi RT, Hoy JF, Landovitz RJ, Thompson MA, Sax PE, Smith DM, Benson CA, Buchbinder SP, Del Rio C, Eron JJ, Fätkenheuer G, Günthard HF, Molina JM, Jacobsen DM, Volberding PA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society-USA Panel. JAMA 2020; 324:1651-1669. [PMID: 33052386 PMCID: PMC11017368 DOI: 10.1001/jama.2020.17025] [Citation(s) in RCA: 287] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. Objective To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV. Evidence Review New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations. Findings From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic. Conclusion and Relevance Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.
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Affiliation(s)
| | - Rajesh T Gandhi
- Harvard Medical School and Massachusetts General Hospital, Boston
| | - Jennifer F Hoy
- Monash University and Alfred Hospital, Melbourne, Australia
| | | | | | - Paul E Sax
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Susan P Buchbinder
- San Francisco Department of Public Health and University of California, San Francisco
| | | | - Joseph J Eron
- School of Medicine, University of North Carolina, Chapel Hill
| | | | - Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jean-Michel Molina
- University of Paris and Saint-Louis/Lariboisière Hospitals, APHP, Paris, France
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14
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Campbell LM, Paolillo EW, Heaton A, Tang B, Depp CA, Granholm E, Heaton RK, Swendsen J, Moore DJ, Moore RC. Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study. JMIR Mhealth Uhealth 2020; 8:e19579. [PMID: 32969829 PMCID: PMC7545331 DOI: 10.2196/19579] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. Objective We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. Methods A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. Results On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (β=−1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (β=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (β=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (β=−.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. Conclusions Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults’ own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior.
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Affiliation(s)
- Laura M Campbell
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States.,Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Emily W Paolillo
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States.,Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Anne Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Eric Granholm
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States.,VA San Diego Healthcare System, San Diego, CA, United States
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Joel Swendsen
- CNRS UMR, University of Bordeaux, Bordeaux, France.,National Center for Scientific Research, Ecole Pratique des Hautes Etudes, PSL Research University, Paris, France
| | - David J Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
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15
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Microalbuminuria: a sentinel of neurocognitive impairment in HIV-infected individuals? J Neurol 2020; 267:1368-1376. [PMID: 31980868 PMCID: PMC7184056 DOI: 10.1007/s00415-019-09674-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/05/2019] [Accepted: 12/11/2019] [Indexed: 12/22/2022]
Abstract
Background According to population-based studies, microalbuminuria is associated with subsequent cognitive decline over a 4–6-year period, because of cerebral small-vessel disease (CSVD). This prospective cross-sectional study (NCT02852772) was designed to evaluate whether a history of microalbuminuria is associated with subsequent cognitive decline in combined antiretroviral therapy (cART)-treated persons living with human immunodeficiency virus (PLHIVs). Methods From our computerized medical database, we identified 30 PLHIVs (median age 52 years), immunovirologically controlled on cART, who had microalbuminuria in 2008 and had undergone, between 2013 and 2015, a comprehensive neuropsychological assessment (NPA) including seven domains (cases): information-processing speed, motor skills, executive functions, attention/working memory, learning/memory, reasoning and verbal fluency. Forty-nine PLHIVs matched for age (median age 48 years; p = 0.19), sex, and year of first HIV-seropositivity without microalbuminuria in 2008 were identified and underwent the same NPA between 2013 and 2015 (controls). Results Cases performed less well than controls for information-processing speed (p = 0.01) and motor skills (p = 0.02), but no differences were found for the other cognitive domains and global z-scores. A multivariable linear-regression model adjusted for confounding factors confirmed the microalbuminuria effect for the information-processing-speed z score. Conclusion cART-treated PLHIVs with a history of microalbuminuria subsequently had worse cognitive performances for the information-processing-speed domain, possibly because of CSVD. Our observations should be considered preliminary findings of a temporal link between microalbuminuria, CSVD, and subsequent cognitive impairment.
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16
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Moulignier A, Costagliola D. Metabolic Syndrome and Cardiovascular Disease Impacts on the Pathophysiology and Phenotype of HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2020; 50:367-399. [PMID: 31989463 DOI: 10.1007/7854_2019_123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence from epidemiological studies on the general population suggests that midlife cardiovascular disease (CVD) and/or metabolic syndrome (MetS) are associated with an increased risk of cognitive impairment and dementia later in life. In the modern combined antiretroviral therapy (cART) era, as in the general population, CVD and MetS were strongly and independently associated with poorer cognitive performances of sustained immunovirologically controlled persons living with human immunodeficiency viruses (PLHIVs). Those findings suggest that CV/metabolic comorbidities could be implicated in the pathogenesis of HIV-associated neurocognitive disorders (HAND) and might be more important than factors related to HIV infection or its treatment, markers of immunocompetence, or virus replication. The association between CVD/MetS and cognition decline is driven by still not well-understood mechanisms, but risk might well be the consequence of increased brain inflammation and vascular changes, notably cerebral small-vessel disease. In this review, we highlight the correspondences observed between the findings concerning CVD and MetS in the general population and virus-suppressed cART-treated PLHIVs to evaluate the real brain-aging processes. Indeed, incomplete HIV control mainly reflects HIV-induced brain damage described during the first decades of the pandemic. Given the growing support that CVD and MetS are associated with HAND, it is crucial to improve early detection and assure appropriate management of these conditions.
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Affiliation(s)
- Antoine Moulignier
- Department of Neurology, Memory Clinic, Fondation Adolphe de Rothschild, Paris, France.
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre-Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.
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